[Metaphors at the end of life: Resilience as resistance or acceptance]. / Metaphern am Lebensende: Resilienz als Widerstand oder Akzeptanz.

The article provides an overview of the research project "Metaphor in end-of-life care", which was conducted at Lancaster University (UK) between 2011 and 2014. The goals of the project were to show a) how patients, family members and healthcare professionals use metaphors to talk about their experiences with and expectations of end-of-life care, b) what experiences and needs are suggested by the use of metaphors by these groups and c) what contribution the results can make to communication in the healthcare system. A corpus consisting of interviews with the various groups of people and their postings in online fora were subject to both manual and semi-automated analyses. The results show that especially the online communications by patients and family members are characterized by violence and journey metaphors. The use of metaphors by these groups suggests a need for solidarity and community and reflects both positive and negative personal experiences. Resilience can be understood as resistance against illness or as acceptance of it.

TGFß activity released from platelet-rich fibrin adsorbs to titanium surface and collagen membranes.

Platelet-rich fibrin (PRF) contains a broad spectrum of bioactive molecules that can trigger several cellular responses. However, these molecules along with their upstream responses remain mostly uninvestigated. By means of proteomics we revealed that PRF lysates contain more than 650 proteins, being TGF-ß one of the few growth factors found. To uncover the major target genes regulated by PRF lysates, gingival fibroblasts were exposed to lysates obtained from PRF membranes followed by a whole genome array. We identified 51 genes strongly regulated by PRF including IL11, NOX4 and PRG4 which are characteristic TGF-ß target genes. RT-PCR and immunoassay analysis confirmed the TGF-ß receptor I kinase-dependent increased expression of IL11, NOX4 and PRG4. The PRF-derived TGF-ß activity was verified by the translocation of Smad2/3 into the nucleus along with the increased phosphorylation of Smad3. Considering that PRF is clinically used in combination with dental implants and collagen membranes, we showed here that PRF-derived TGF-ß activity adsorbs to titanium implants and collagen membranes indicated by the changes in gene expression and immunoassay analysis. Our study points towards TGF-ß as major target of PRF and suggest that TGF-ß activity released by PRF adsorbs to titanium surface and collagen membranes.

The online use of Violence and Journey metaphors by patients with cancer, as compared with health professionals: a mixed methods study.

OBJECTIVE: To compare the frequencies with which patients with cancer and health professionals use Violence and Journey metaphors when writing online; and to investigate the use of these metaphors by patients with cancer, in view of critiques of war-related metaphors for cancer and the adoption of the notion of the 'cancer journey' in UK policy documents. DESIGN: Computer-assisted quantitative and qualitative study of two data sets totalling 753 302 words. SETTING: A UK-based online forum for patients with cancer (500 134 words) and a UK-based website for health professionals (253 168 words). PARTICIPANTS: 56 patients with cancer writing online between 2007 and 2012; and 307 health professionals writing online between 2008 and 2013. RESULTS: Patients with cancer use both Violence metaphors and Journey metaphors approximately 1.5 times per 1000 words to describe their illness experience. In similar online writing, health professionals use each type of metaphor significantly less frequently. Patients' Violence metaphors can express and reinforce negative feelings, but they can also be used in empowering ways. Journey metaphors can express and reinforce positive feelings, but can also be used in disempowering ways. CONCLUSIONS: Violence metaphors are not by default negative and Journey metaphors are not by default a positive means of conceptualising cancer. A blanket rejection of Violence metaphors and an uncritical promotion of Journey metaphors would deprive patients of the positive functions of the former and ignore the potential pitfalls of the latter. Instead, greater awareness of the function (empowering or disempowering) of patients' metaphor use can lead to more effective communication about the experience of cancer.